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The Oberheiden & McMurrey, LLP is a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our attorneys are the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented attorneys with years of relevant experience and education from the country’s best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in New Orleans and surrounding areas.

Health care service providers and other companies in the health care industry in New Orleans are at risk for severe penalties resulting from government investigations and private citizen-initiated “qui tam” lawsuits under the False Claims Act. Federal enforcement efforts and qui tam complaints have both been on the rise due to some recent high-profile Medicare fraud stings in New Orleans, and at Oberheiden & McMurrey, LLP, our nationally recognized Health Care Fraud Defense Group is actively representing clients in False Claims Act matters in New Orleans and nationwide.

If you are facing a False Claims Act investigation, or if you or your company has been named in a qui tam complaint, you need to act fast. Delays can significantly harm your defense. We urge you to contact us immediately so that we can make contact with the government and start building your defense strategy right away.

New Orleans is a Key Target in the Government’s Fight Against False Claims

Due to its high number of federal health care benefit program (Medicare, Medicaid, and Tricare) participants, New Orleans has long been at the center of the federal government’s fight against fraud. Recently, however, federal prosecutors in New Orleans have announced that they are placing particular emphasis on combatting false claims involving home health services. According to a recent announcement from the U.S. Attorney’s Office in New Orleans, there is “no end in sight for indictments” when it comes to False Claims Act violations involving Medicare and homebound patients.

Of course, home health providers aren’t the only ones in the federal government’s crosshairs. Due to high levels of fraud across health care industry sectors in New Orleans, the government’s elite Health Care Fraud Prevention and Enforcement Action Team (HEAT) and other federal authorities – including the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), and the Federal Bureau of Investigation (FBI) – are actively pursuing investigations and prosecutions for False Claims Act violations in the local area.

What Providers Need to Know about the False Claims Act

What does it take to “knowingly” submit a false or fraudulent claim under the False Claims Act?

The False Claims Act makes it illegal to “knowingly” submit a false or fraudulent claim for payment under a federal government contract or pursuant to a federal health care benefit program. However, in order to “knowingly” submit a false or fraudulent claim, it is enough that you “should have known” that the claim constituted a violation. As a result, you do not actually have to know that a claim is false or fraudulent in order to “knowingly” submit a reimbursement request in violation of the False Claims Act. This means that the following all constitute potential violations of the False Claims Act:

Mistakenly using an outdated billing code after an update to the Medicare billing system

Double-billing (maybe even if done accidentally)

Unbundling and upcoding reimbursable services

Billing for services, supplies, equipment, or medications that were not ordered or provided

Billing for services, supplies, equipment, or medications that were medically unnecessary

What are the penalties for submitting false and fraudulent claims under the False Claims Act?

The False Claims Act provides for both civil and criminal penalties. Criminal penalties apply when the government alleges that you “intentionally” (not just “knowingly”) submitted a false or fraudulent claim. The penalties under the False Claims Act are as follows:

Civil penalties can include three times the government’s losses (“treble damages”), plus fines of up to $11,000 per false claim.

Criminal penalties (18 U.S.C. § 287) can include up to to five years of federal imprisonment and, in felony cases, fines of up to $250,000 (for individuals) or $500,000 (for companies) per false claim. In misdemeanor cases, the maximum fines are reduced to $100,000 and $200,000, respectively.

Have You Been Accused of Violating the False Claims Act in a “Qui Tam” Complaint?

In many cases, False Claims Act cases arise not out of government interest in a particular provider, but instead out of a former employee’s or competitor’s accusations.

Under the “qui tam” provisions of the False Claims Act, private citizens (referred to as “relators”) have the ability to file lawsuits to recover monies on behalf of the federal government (see 31 U.S.C. § 3729). Since qui tam litigation can be highly disruptive and relators are entitled to a portion of any amount the government recovers, qui tam actions alleging fraudulent billing practices under Medicare and other federal benefit programs have grown to become a major problem for health care providers in New Orleans and across the United States.

Here is what you can expect if you or your company has been named in a qui tam lawsuit in New Orleans:

The Complaint. The relator files a complaint in the U.S. District Court for the Eastern District of Louisiana alleging submission of a false or fraudulent claim. In order to protect the relator, the complaint is filed under seal (meaning that only the assigned judge and select government officials will have access to the non-public complaint).

Initial Assessment. Next, the government conducts an initial assessment to determine whether it should get involved. If the relator’s allegations appear to be legitimate, the government will conduct an investigation – typically by issuing subpoenas requiring production of any records that may indicate the defendant has submitted a false or fraudulent claim.

Government Intervention. Following its investigation, the government will decide whether to intervene in the litigation. If it does not intervene, the relator can still pursue its complaint independently. If the government does intervene, it will typically amend the qui tam complaint to include additional allegations under the Anti-Kickback Statute, the Truth in Negotiation Act, and other federal laws.

Settlement Negotiations. Beginning as early in the case as possible, prosecutors from the DOJ will be in regular contact with the defendant’s attorneys with regard to the possibility of negotiating a settlement. The sooner you hire an attorney, the better the chances that you will be able to secure a favorable settlement and avoid facing charges.

Liability and Relator Compensation. If the case results in civil liability, the defendant will face penalties based upon the volume and extent of the fraudulent practices involved. Remember: The government can seek triple damages plus civil fines of $11,000 per false claim. Under the False Claims Act’s qui tam provisions, the relator will receive up to 25 percent of the amount recovered if the government intervened, or up to 30 percent if the relator pursued the case independently.

Three Stages of a Successful False Claims Act Defense

With decades of experience as federal prosecutors and defense attorneys in False Claims Act investigations, the attorneys in our Health Care Fraud Defense Group have developed a proven strategy for defeating unsubstantiated complaints and fending off charges in unwarranted federal investigations. We pursue the following three key outcomes in all False Claims Act cases in New Orleans, LA:

No Criminal Charges

When we take your case, our first priority will be to make sure that you avoid criminal charges. We want to make sure you avoid jail time, and we want to limit the scope of the government’s investigation.

No Government Intervention

In qui tam actions, we aggressively confront relators, challenge their allegations, and pursue all opportunities to destroy their credibility. If we can convince the government that the relator’s claims are unsubstantiated, the government won’t get involved in your case.

Negotiation of a Favorable Civil Settlement

Finally, if civil liability appears certain, we will seek to negotiate your overall liability to a mere fraction of the government’s demand. To date, not a single one of our False Claims Act settlements has involved our client ceasing operations or closing their business.

False Claims Act Defense Attorneys Serving New Orleans, LA

Founder of Oberheiden & McMurrey, LLP, Dr. Nick Oberheiden is a nationally recognized health care fraud defense lawyer who represents individual and corporate clients in complex health care fraud matters. He is regularly called upon to represent clients in qui tam litigation as well as investigations and prosecutions under the False Claims Act, the Anti-Kickback Statute, and other federal laws. Dr. Oberheiden has successfully represented clients before virtually all federal agencies, including the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the Department of Defense (DOD), the Department of Justice (DOJ), and the Department of Labor (DOL).

Another of Oberheiden & McMurrey, LLP’s former federal prosecutors, Lynette S. Byrd offers extensive experience in complex federal cases involving allegations under the False Claims Act and other federal anti-fraud laws. As a former Assistant United States Attorney (AUSA), Ms. Byrd offers clients important insights into how and why the Department of Justice investigates and prosecutes individuals and companies suspected of federal program fraud.

We are available to discuss your case. Call us directly or complete our contact form to schedule your free, confidential case evaluation today.

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.